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PENNSYLVANIA CLAIMS REPORTING:

EMPLOYER CHECKLIST

  • WHAT TO DO WHEN AN INJURY OCCURS:
     
    •  In an emergency, take your injured employee to the
    nearest emergency facility.
    •  For all work-related injuries, provide the list of panel
    physicians to the injured employee.
     
    •  The incident report is the injured employee’s statement of what happened. Have the injured employee 
    completethis form and keep a copy of this document for your records.  Email the completed form to 
    the HR Office, kraynakl@hasdpa.net or strickenglossp@hasdpa.net
     
    • This form explains the employee’s rights under the Pennsylvania workers’ compensation                                                       
    law that must be signed by employees at the time of injury.
    •  This form also includes the list of panel physicians selected by the employer.
    •  Provide a signed copy of the forms to the injured employee and to the HR office.
     
     
    •  This form authorizes BrickStreet Insurance to request medical records related to the injured 
    employee's claim.
     
    •  Have the injured employee take this form to his/her treating physician, which will include any 
  • restrictions the employee may have.
Physician Panel of work related injury physicians.  Please contact a physician on this list to be evaluated.
 
 
  • Instruct injured employee to utilize the First Fill Form toobtain prescriptions related to the work 
  • injury and prior to acceptance of the claim.
  • Instruct injured employee that upon acceptance of the claim, a medical identification card will be
  • mailed. This card should be presented to the pharmacy when having future work-related
  • prescriptions filled.
 
 
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